The development of intestinal dysbiosis in anemic preterm infants

J Perinatol. 2020 Jul;40(7):1066-1074. doi: 10.1038/s41372-020-0599-z. Epub 2020 Jan 28.


Objective: Anemia and Proteobacteria-dominant intestinal dysbiosis in very low birth weight (VLBW) infants have been linked to necrotizing enterocolitis, a severe gut inflammatory disease. We hypothesize that anemia of prematurity is related to the development of intestinal dysbiosis.

Study design: Three hundred and forty-two weekly stool samples collected prospectively from 80 VLBW infants were analyzed for bacterial microbiomes (with 16S rRNA). Linear mixed-effects model was used to determine the relationships between the onsets of anemia and intestinal dysbiosis.

Results: Hematocrit was associated with intestinal microbiomes, with lower Hct occurring with increased Proteobacteria and decreased Firmicutes. Infants with a hematocrit <30% had intestinal microbiomes that diverged toward Proteobacteria dominance and low diversity after the first postnatal month. The microbiome changes were also related to the severity of anemia.

Conclusions: This finding supports a potential microbiological explanation for anemia as a risk factor for intestinal dysbiosis in preterm infants.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anemia*
  • Dysbiosis
  • Enterocolitis, Necrotizing* / epidemiology
  • Feces
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • RNA, Ribosomal, 16S / genetics


  • RNA, Ribosomal, 16S